Survival Benefit of Lung Transplantation in the Modern Era of Lung Allocation.

TitleSurvival Benefit of Lung Transplantation in the Modern Era of Lung Allocation.
Publication TypeJournal Article
Year of Publication2017
AuthorsVock, David M., Michael T. Durheim, Wayne M. Tsuang, Ashley Finlen C Copeland, Anastasios A. Tsiatis, Marie Davidian, Megan L. Neely, David J. Lederer, and Scott M. Palmer
JournalAnn Am Thorac Soc
Date Published2017 Feb
KeywordsAdult, Cystic Fibrosis, Female, Health Care Rationing, Humans, Lung Diseases, Obstructive, Lung Transplantation, Male, Middle Aged, Patient Selection, Registries, Retrospective Studies, Survival Rate, Time Factors, Tissue and Organ Procurement, Tissue Donors, United States, Waiting Lists, Young Adult

RATIONALE: Lung transplantation is an accepted and increasingly employed treatment for advanced lung diseases, but the anticipated survival benefit of lung transplantation is poorly understood.OBJECTIVES: To determine whether and for which patients lung transplantation confers a survival benefit in the modern era of U.S. lung allocation.METHODS: Data on 13,040 adults listed for lung transplantation between May 2005 and September 2011 were obtained from the United Network for Organ Sharing. A structural nested accelerated failure time model was used to model the survival benefit of lung transplantation over time. The effects of patient, donor, and transplant center characteristics on the relative survival benefit of transplantation were examined.MEASUREMENTS AND MAIN RESULTS: Overall, 73.8% of transplant recipients were predicted to achieve a 2-year survival benefit with lung transplantation. The survival benefit of transplantation varied by native disease group (Pā€‰=ā€‰0.062), with 2-year expected benefit in 39.2 and 98.9% of transplants occurring in those with obstructive lung disease and cystic fibrosis, respectively, and by lung allocation score at the time of transplantation (Pā€‰<ā€‰0.001), with net 2-year benefit in only 6.8% of transplants occurring for lung allocation score less than 32.5 and in 99.9% of transplants for lung allocation score exceeding 40.CONCLUSIONS: A majority of adults undergoing transplantation experience a survival benefit, with the greatest potential benefit in those with higher lung allocation scores or restrictive native lung disease or cystic fibrosis. These results provide novel information to assess the expected benefit of lung transplantation at an individual level and to enhance lung allocation policy.

Alternate JournalAnn Am Thorac Soc
Original PublicationSurvival benefit of lung transplantation in the modern era of lung allocation.
PubMed ID27779905
PubMed Central IDPMC5427730
Grant ListR01 CA085848 / CA / NCI NIH HHS / United States
U01 AI113315 / AI / NIAID NIH HHS / United States
R37 AI031789 / AI / NIAID NIH HHS / United States
P01 CA142538 / CA / NCI NIH HHS / United States
K24 HL131937 / HL / NHLBI NIH HHS / United States
R01 HL118336 / HL / NHLBI NIH HHS / United States